=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508616673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEANA SCHUPLIN, LMHC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2024
-----------------------------------------------------
Last Update Date | 03/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1441 29TH ST STE 209
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50266-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-418-7725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1441 29TH ST STE 209
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50266-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-418-7725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | DEANA SCHUPLIN
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 515-418-7735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------